Poliomyelitis

Definition
Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
In the U.S., the last case of naturally occurring polio happened in 1979. Today, despite a concerted global eradication campaign, poliovirus
continues to affect children and adults in Afghanistan, Pakistan and some African countries.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you're traveling anywhere there's a
risk of polio.
If you're a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated
poliovirus vaccine (IPV). Immunity after a booster dose lasts a lifetime.

Symptoms

Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don't become sick and are never
aware they've been infected with polio.

Nonparalytic polio

Some people who develop symptoms from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive
polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.

Signs and symptoms, which generally last one to 10 days, include:

 Fever
 Sore throat

 Headache

 Vomiting

 Fatigue

 Back pain or stiffness

 Neck pain or stiffness

 Pain or stiffness in the arms or legs

 Muscle weakness or tenderness

 Meningitis

Paralytic polio

In rare cases, poliovirus infection leads to paralytic polio, the most serious form of the disease. Paralytic polio has several types, based on the part
of your body that's affected — your spinal cord (spinal polio), your brainstem (bulbar polio) or both (bulbospinal polio).

Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, signs
and symptoms specific to paralytic polio appear, including:

 Loss of reflexes
 Severe muscle aches or weakness
  Loose and floppy limbs (flaccid paralysis), often worse on one side of the body

Post-polio syndrome

Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people several years — an average of 35 years — after they
had polio. Common signs and symptoms include:

 Progressive muscle or joint weakness and pain

 General fatigue and exhaustion after minimal activity

 Muscle atrophy

 Breathing or swallowing problems

 Sleep-related breathing disorders, such as sleep apnea

 Decreased tolerance of cold temperatures

 Cognitive problems, such as concentration and memory difficulties

 Depression or mood swings

Causes
The poliovirus resides only in humans and enters the environment in the feces of someone who's infected. Poliovirus spreads primarily through
the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so
contagious that anyone living with a recently infected person is likely to become infected, too. People carrying the poliovirus can spread the virus
for weeks in their feces.

Risk factors

You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent
immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune
systems — are especially susceptible to experience paralysis if they are infected with poliovirus.

These factors also increase your risk if you haven't been vaccinated:

 Travel to an area where polio is common or that has recently experienced an outbreak

 Living with or caring for someone who may be shedding poliovirus

 A compromised immune system, such as occurs with HIV infection

 Having had your tonsils removed (tonsillectomy)

 Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system

Complications
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many
deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still
common. As a result, children who survive polio may spend their lives with severe disabilities.
Pathophysiology
Acute poliomyelitis is caused by small ribonucleic acid (RNA) viruses of the enterovirus group of the picornavirus family. The single-stranded
RNA core is surrounded by a protein capsid without a lipid envelope, which makes poliovirus resistant to lipid solvents and stable at low pH.
Three antigenically distinct strains are known, with type I accounting for 85% of cases of paralytic illnesses. Infection with one type does not
protect from the other types; however, immunity to each of the 3 strains is lifelong.

The enteroviruses of poliomyelitis infect the human intestinal tract mainly through the fecal-oral route (hand to mouth). The viruses multiply in
oropharyngeal and lower gastrointestinal tract mucosa during the first 1-3 weeks of the incubation period. Virus may be secreted in saliva and
feces during this period, causing most host-to-host transmission. After the initial alimentary phase, the virus drains into the cervical and
mesenteric lymph nodes and then into the blood stream. Only 5% of infected patients have selective nervous system involvement after viremia. It
is believed that replication in extraneural sites maintains the viremia and increases the likelihood that the virus will enter the nervous system.

The poliovirus enters the nervous system by either crossing the blood-brain barrier or by axonal transportation from a peripheral nerve. It can
cause nervous system infection by involving the precentral gyrus, thalamus, hypothalamus, motor nuclei of the brainstem and surrounding
reticular formation, vestibular and cerebellar nuclei, and neurons of the anterior and intermediate columns of the spinal cord. The nerve cells
undergo central chromatolysis along with an inflammatory reaction while multiplication of the virus precedes onset of paralysis. As the
chromatolysis process goes on further, muscle paralysis or even atrophy appears when fewer than 10% of neurons survive in the corresponding
cord segments. Gliosis develops when the inflammatory infiltrate has subsided, but most surviving neurons show full recovery.

Tests and diagnosis

Doctors often recognize polio by symptoms, such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To
confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid — a colorless fluid that surrounds your brain and spinal cord —
is checked for the presence of poliovirus.

Treatments and drugs

Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments
include:

 Bed rest
 Pain relievers

 Portable ventilators to assist breathing

 Moderate exercise (physical therapy) to prevent deformity and loss of muscle function

 A nutritious diet

Prevention

By Mayo Clinic Staff

Although improved public sanitation and careful personal hygiene may help reduce the spread of polio, the most effective way to prevent the
disease is with polio vaccine.

Polio vaccine

Currently, most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages:

 Two months
 Four months

 Between 6 and 18 months

 Between ages 4 and 6 when children are just entering school

IPV is 90 percent effective after two shots and 99 percent effective after three. It can't cause polio and is safe for people with weakened immune
systems, although it's not certain just how protective the vaccine may be in cases of severe immune deficiency. Common side effects are pain and
redness at the injection site.

Allergic reaction to the vaccine

IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and
neomycin, it shouldn't be given to anyone who's had a reaction to these medications.

Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot and may include:

 Difficulty breathing
 Weakness

 Hoarseness or wheezing

 Rapid heart rate

 Hives

 Dizziness

 Unusual paleness

 Swelling of the throat

If you or your child experiences an allergic reaction after any shot, get medical help immediately.

Fewer shots for your child

Polio vaccine is normally given in conjunction with vaccinations against other diseases, including diphtheria, tetanus and acellular pertussis
(DTaP), pneumococcal infections, and hepatitis B. But your child may not need to receive all these injections separately.

A combination vaccine called Pediarix is available that reduces the number of injections given during the first two years of life. Pediarix
combines DTaP, hepatitis B and polio vaccine into a single vaccine. Side effects of Pediarix are similar to those of the individual vaccines
administered separately, though fever is more likely to occur in children who receive Pediarix than in children who receive vaccines separately.

Adult vaccination

In the U.S., adults aren't routinely vaccinated against polio because most are already immune and the chances of contracting polio are minimal.
However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should
receive a single booster shot of IPV. A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the
world where polio still occurs or those who care for people who may be excreting wild poliovirus.

If you're unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots — two doses of IPV at four– to
eight–week intervals and a third dose six to 12 months after the second dose.